经食管黏膜下隧道内镜治疗大面积食管黏膜病变的价值

目的探讨经食管黏膜下隧道内镜治疗大面积食管黏膜病变的应用价值。 方法徐州医科大学附属淮安医院2015年1月至2017年7月经胃镜及病理诊断大面积食管高级别上皮内瘤变18例，采用随机数字表法分为传统内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)法及经食管黏膜下隧道法切除病变，对比及随访观察治疗效果。 结果隧道组均于术中一次性完整剥离切除，一次性整块切除率均为100%，经典ESD组1例圈套器辅助分片切除，一次性整块切除率均为88.9%，术后病理结果提示所有切除标本的侧切缘和基底切缘无肿瘤累及。病变切除的平均直径隧道组为(7.5±3.2)cm，经典ESD组为(8.3±1.4)cm，2组在病变切除面积差异无统计学意义(P>0.05)；平均手术时间隧道组为(50.4±28.0)min，经典ESD组为手术时间(82.5±29.7)min，2组在一次性整块切除率、平均手术时间方面，差异有统计学意义(P<0.05)。隧道技术组术中无1例皮下气肿；剥离过程无环形肌受伤害；经典ESD组术中出现纵隔、皮下气肿2例，其中小穿孔的1例应用钛夹缝合，术后3 d气肿均自行消失，术后24 h内出现发热1例，伴有白细胞升高，抗炎对症处理后第2天完全缓解，差异有统计学意义(P<0.05)。 结论内镜经食管黏膜下隧道技术是大面积食管黏膜病变切除安全有效的方法，能有效降低内镜下病变切除的难度，缩短手术时间，减少并发症发生。

Value of endoscopic submucosal tunnel resection of large area esophageal mucosal lesions

ObjectiveTo investigate the value of endoscopic submucosal tunnel resection of large area esophageal mucosal lesions. MethodsBetween January 2015 and June 2017, 18 patients with large area esophageal high grade epithelial neoplasia confirmed by pathology were collected.All the patients were divided into two groups using random number table method.The patients in control group were treated with traditional endoscopic submucosal dissection(ESD), and the patients in test group were treated with submucosal tunnel resection.The therapeutic effect of the two groups were observed and compared. ResultsThe total removal rate of the tunnel group was 100%.In the classic ESD group, 1 case was fractionally excised by a snare, and the total removal rate was 88.9%.The postoperative pathological results showed that the lateral cutting edge and basal cutting edge of the excised specimen were complete in the two groups of lesions.The maximum diameters in tunnel group and classic ESD group were(7.5±3.2)cm and(8.3±1.4)cm respectively, and the difference of the lesion resection area was not statistically significant between the two groups(P>0.05). The operation times in tunnel group and classic ESD group were(50.4±28.0)min and(82.5±29.7)min.There was significant difference between the two groups in lump-sum slice and average operation time(P<0.05). There was no subcutaneous emphysema in tunnel group, and the stripping process has no ring muscle injury.In classic ESD group, there were 2 cases of mediastinal and subcutaneous emphysema, of which 1 case of small perforation was applied with titanium clip, and the emphysema disappeared by itself 3 days after operation.There was a fever of 1 in 24 h after operation, accompanied by elevated white blood cell, and the symptom was completely relieved in the second day after treatment.The incidence of complications between the two groups has significant statistical significance(P<0.05). ConclusionUsing submucosal tunnel technology for the treatment of large area esophageal mucosal lesion is a safe and effective method.It can effectively reduce the difficulty of endoscopic lesion resection, shorten the operation time, and reduce the complications.